Analysing the Nonsense Statement: “The top six vitamins you shouldn’t take”
With the all-out assaults from the lackeys of the “Friends of Science in Medicine” this week in the Australian media, I thought I would take a representative sample of the sort of nonsense that is being perpetuated, from an article published in the daily Telegraph on Saturday 11th of February. This article was titled ‘Vitamins : The Great Rip-off.’
The ill-informed journalist quoted the usual statistics about the amount of people in Australia consuming vitamins, basically suggesting they are wasting their money. As I have already addressed the issue in my last article on the subject around the proven science behind vitamin supplementation, I thought I would address the six specific examples this journalist gave, as these are very representative of the incredibly flawed arguments coming from the Friends of Science in Medicine and other critics of natural therapies.
- “Vitamin C won’t cure a cold and megadoses can actually increase the risk for kidney stones.” One study performed in 2007 using only 200 mg daily of vitamin C did, in fact, show a small but definite reduction in common cold duration & intensity but despite this the conclusion was that vitamin C does not prevent the common cold. It is my opinion from clinical experience that the use of 2 to 4 g daily of vitamin C at the onset of cold when taken with echinacea, garlic and possibly zinc, does have a reasonable benefit to reduce the days suffered and the intensity of cold symptoms. But, anyone in medicine knows that as of 2017 there is no cure for the common cold, so why vitamin C would have any magical properties over any other failed therapies, especially at the lower doses suggested is rather illogical, especially when stronger synthetic therapies have failed to do anything. Kidney stones – A study of just under 23,400 Swedish men over 10 years looked at those who didn’t consume supplements and those who took vitamin C. 22,500 men didn’t take vitamin C supplements and just over 900 men took vitamin C. They did not look at the dosing schedule nor how often the vitamin C was consumed. Over this 10 year period, 31 men out of 23,400 experienced a kidney stone and this was more common in the group that had, at some stage, consumed vitamin C. This was not a randomised controlled trial and as I’ve stated, the vitamin C dosage was not analysed. Interestingly, there are some contradictory studies of high-dose vitamin C which have suggested reduction in kidney stones. Kidney stones, in the vast majority of cases, are mainly calcium oxalate. and the science is extremely variable around the interaction between vitamin C and oxalate metabolism.
- “Vitamin A and beta-carotene increase cancer risk.” This information comes from an article published in the New England Journal of Medicine in 1994 where high doses of synthetic beta-carotene were given to smokers and/or people who had been exposed to asbestos and showed that with 30 mg daily beta-carotene and 25,000 I.U. vitamin A, there were slightly higher cancer and death rates compared with people who are given placebo. The second trial was the ATBC trial of 29,000 Finnish smokers given 20 mg daily of synthetic beta-carotene and synthetic vitamin E 50 I.U. daily. Conservative researchers who do not understand complementary medicine use the cheaper, ineffective and sometimes harmful synthetic vitamins, purely to save money in large clinical trials. Any research conducted with synthetic vitamins should be ignored and only reinforces the need to use high-quality, natural pharmaceutical-grade supplements, which are the vast majority of vitamins used in Australia.
- “Vitamin E: Another supposed anticancer supplement, but it has been shown to elevate it.” The journalist again demonstrates the same ignorance around the difference between synthetic and natural vitamins by quoting two trials including the aforementioned ATBC Finnish smokers trial and the newer SELECT trial of 35,000 men with prostate cancer followed for seven years. In both trials, synthetic vitamin E was used. In the ATBC trial, a very small dose of 50 international units was used but a higher dose was used in the SELECT trial. By understanding this simple difference between synthetic and natural vitamins, you can clearly see the journalist’s mistake. Just so you know, the next time you go into a health food store to pick up your vitamin E, synthetic vitamin E is dl-Alpha tocopherol, whereas natural vitamin E is d-alpha tocopherol — a small but significant difference on the label! As I mentioned in my previous article on this subject, there has only been two trials in the history of evidence based medicine which have looked at the combination of natural vitamin E with vitamin C and both of these trials showed a 25% reduction in the progression of atherosclerosis. These trials were the IVUS and ASAP trials.
- “Vitamin B6: Can cause nerve damage if taken for an extended period.” This is a great example of the cherry picking of evidence. There has been one trial performed many years ago suggesting that if you took more than 200 mg daily of vitamin B6, it may cause a degree of reversible nerve damage. The average dose of B6 in most supplements is 10 to 25 mg daily and no harm to the nerves has ever been demonstrated at this dose. If you have a headache and I give you two paracetamol, I may take away your headache. If I give you the entire box I may cause irreversible liver damage. Does this mean you should never take paracetamol? The Optima trial performed in Oxford University by Prof David Smith looked at 271 people with mild cognitive impairment, the precursor of Alzheimer’s disease. Professor Smith, in this randomised, controlled trial, gave half the participants a placebo whilst the other half were given the active treatment of folic acid 800 µg daily, B12 1000 µg daily and vitamin B 25 mg daily. All the participants were assessed with neurocognitive testing and MRI to confirm the diagnosis. These tests were repeated two years later and those with the active vitamin treatment had a 30% reduction in progression to Alzheimer’s disease. Those who had the highest homocysteine levels had a 50% reduction in progression to Alzheimer’s disease when given the high-dose B group vitamins. Clearly the journalists got this one wrong.
- “Multivitamins: A study of 39,000 older women found they increased death risk.” This particular study was known as the Iowa Women’s Study and followed this group of women for a 19 year period. It found that 41% of the women who were in the multivitamin group compared with 40% of women who were non-users, died over the 19 year period. This was an observational trial that did not actually look at the frequency and intensity of multivitamin use, but purely relied on questionnaires filled in by the women as to whether they had taken multivitamins at some stage during the study period. A 1% difference in death in this study for anyone who has a modicum of understanding of statistics is completely irrelevant and means nothing. Also, Iowa is a blue collar area; lower socio-economic groups typically do not follow as good a diet as people living in more affluent areas, such as Boston where the male physicians trial and nurses health study were performed. No one could possibly suggest that a vitamin in any way shape or form could overcome the effects of a poor diet, whereas in the Boston studies it demonstrated a clear added benefit by adding multivitamins to healthy eating patterns.
- “Vitamin D: Waste of money. Ten minutes of sunlight will do the job.” How I wish this was true… The sad fact is that one in three Australians have a proven vitamin D deficiency. Of course, we do live in the skin cancer capital of the world. People, reasonably so, are avoiding excessive sunlight! There is a clear link between low vitamin D levels and osteoporosis, cardiovascular disease, cancer, multiple sclerosis, Type II diabetes, depression and asthma, to name a few. A recent study in heart failure showed that giving 4000 I.U. daily of vitamin D improves cardiac function as good as standard medical therapy. Hardly a waste of money!
My problem with ill-informed people writing these types of non-scientific articles is the pathetic cherry picking of evidence with no understanding of the overall picture. With my 35 years of practising medicine and reviewing multiple studies of supplementation, not to mention being involved in a number of clinical studies published in well-respected medical journals on complementary medicine, it is an increasing source of bemusement and frustration when I keep hearing this nonsense from conservative groups such as the Friends of Science in Medicine and ill-informed journalists.
It is my opinion that we continue to hear this nonsense for the following reasons:
- There is a belief amongst some parts of the general public that more is better in regard to supplements or that inappropriate doses actually work rather than learning proper dosing schedules e.g. high dose vitamin B6 would be better than appropriate dose, a small dose of vitamin C may help a cold
- The inappropriate use of vitamins in the wrong groups e.g. nothing will overcome the damaging effects of smoking, asbestos or poor dietary choices.
- The difference between inexpensive, poor quality synthetic supplements used in many clinical trials to reduce the cost of the trial, compared with using high quality pharmaceutical grade naturally sourced supplements.
Vitamin supplements are not miracle drugs, they are supplements to healthy lifestyle principles. When healthy groups of people who practice healthy lifestyle principles also take appropriate, high-quality supplements for a prolonged period of time (from my analysis of literature, my own involvement in clinical trials and clinical experience), the evidence for benefit is overwhelming.